Date of Award

9-6-2024

Degree Type

Thesis

Degree Name

Master of Arts (MA)

Department

Psychology

First Advisor

Grayson Holmbeck

Abstract

Spina bifida (SB) is a birth defect that impacts physical, medical, and neuropsychological functioning. Physical complications like hydrocephalus and bladder dysfunction require daily adherence to complex medical regimens. Additionally, youth with SB are more likely to have symptoms of anxiety and depression which can impact their ability to master their regimens. Evidence in other pediatric populations have examined the impact of family factors, like parental stress, and individual-level predictors of self-management outcomes, yet few have examined how the broader context, like neighborhoods, impact outcomes. Therefore, the current study examined (1) the level of the neighborhood vulnerability and acute healthcare services within the sample, (2) associations between neighborhood factors and parental stress and youth internalizing symptoms, (3) associations between parental stress and youth internalizing symptoms and medical adherence, (4) the degree to which neighborhood factors predict medical adherence, and (5) the mediating role of parental stress and youth internalizing symptoms on associations between neighborhood factors medical adherence in youth with SB. One hundred and thirty youth with SB were enrolled in a larger longitudinal study (Kayle et al., 2020). The current study included youth home addresses and parent report of experiences of stress. Youth internalizing symptoms were assessed via youth-, parent- and teacher-report and medical adherence was assessed via parent-report. Results indicated that a majority of youth with SB live in a mid to high vulnerable neighborhood with no hospitals. Neighborhood factors were not significant predictors of parental stress or youth internalizing symptoms. Parental stress and youth internalizing symptoms were not significant predictors of youth medical adherence. Similarly, neighborhood factors were not significant predictors of youth medical adherence. This study highlights the need for providers to consider larger contexts, including neighborhoods, when supporting youth with SB and their families and the need for additional research to explore other outcomes like neuropsychological and academic functioning that may be impacted by neighborhood factors.

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